Medicare Compliance & Reimbursement
Compliance:
Know Your Rights and Responsibilities in Possible Healthcare Fraud Cases
Honesty really is the best policy. Government enforcement efforts under the False Claims ... Read more
Know Your Rights and Responsibilities in Possible Healthcare Fraud Cases
Honesty really is the best policy. Government enforcement efforts under the False Claims ... Read more
Medicare Regulations:
Pocket These Tips for Categorizing Medicare and VA Claims Correctly
Don't let confusion about where to submit a government payer claim derail your reimburseme... Read more
Pocket These Tips for Categorizing Medicare and VA Claims Correctly
Don't let confusion about where to submit a government payer claim derail your reimburseme... Read more
Medicare Regulations:
Use an Additional Code for ACP Conversation
Question: My provider is conducting conversations about advance care planning (ACP) during... Read more
Use an Additional Code for ACP Conversation
Question: My provider is conducting conversations about advance care planning (ACP) during... Read more
Compliance:
Rely on These Resources for CDI Research
Question: Which resources are useful in the daily workflow of clinical documentation integ... Read more
Rely on These Resources for CDI Research
Question: Which resources are useful in the daily workflow of clinical documentation integ... Read more
Compliance:
Bolster Continuity of Care Through Documentation
Question: I feel like providers are grateful for billers and coders for sorting through so... Read more
Bolster Continuity of Care Through Documentation
Question: I feel like providers are grateful for billers and coders for sorting through so... Read more
Medicare Regulations:
Know Obligations in Case of Bankruptcy
Question: Does a medical practice have any obligations to Medicare or Medicare Administrat... Read more
Know Obligations in Case of Bankruptcy
Question: Does a medical practice have any obligations to Medicare or Medicare Administrat... Read more
Medicare Regulations:
Look for Payment for Some HIV Drugs as Additional Preventive Services
Question: Does the Centers for Medicare & Medicaid Services (CMS) cover medication for... Read more
Look for Payment for Some HIV Drugs as Additional Preventive Services
Question: Does the Centers for Medicare & Medicaid Services (CMS) cover medication for... Read more
Medicare Regulations:
Find Appropriate Payer Order
Question: One of our patients is 69 but their spouse is 63 and works for a mom-and-pop bus... Read more
Find Appropriate Payer Order
Question: One of our patients is 69 but their spouse is 63 and works for a mom-and-pop bus... Read more
Medicare Regulations:
Medicare Preventive Services Get a Boost for 2025
CMS changes will enable providers to detect problems earlier, when treatment is most effec... Read more
Medicare Preventive Services Get a Boost for 2025
CMS changes will enable providers to detect problems earlier, when treatment is most effec... Read more
Compliance:
Make Monitoring a Linchpin of Your Compliance Program
Compliance officers can delegate monitoring processes to managers and supervisors. The U.... Read more
Make Monitoring a Linchpin of Your Compliance Program
Compliance officers can delegate monitoring processes to managers and supervisors. The U.... Read more
Compliance:
See What Distinguishes a Diligence Audit
Question: I'm reading more about compliance and recently saw the term “diligence audit.... Read more
See What Distinguishes a Diligence Audit
Question: I'm reading more about compliance and recently saw the term “diligence audit.... Read more
Compliance:
Establish Policies to Reach Audit Goals
Question: I know audit policies are part of a comprehensive compliance program, but what s... Read more
Establish Policies to Reach Audit Goals
Question: I know audit policies are part of a comprehensive compliance program, but what s... Read more
Medicare Regulations:
Beware More Oversight Coming for Remote Patient Monitoring
More remote capabilities may mean more responsibilities — and oversight. In September 2... Read more
Beware More Oversight Coming for Remote Patient Monitoring
More remote capabilities may mean more responsibilities — and oversight. In September 2... Read more
Compliance:
Stick to Same DOS to Stay Compliant
Question: Can the time spent by the doctor preparing for a patient's appointment a da... Read more
Stick to Same DOS to Stay Compliant
Question: Can the time spent by the doctor preparing for a patient's appointment a da... Read more
Medicare Regulations:
Find Clarity on MSP Types
Question: I'm trying to navigate situations in which a patient is a Medicare beneficiary b... Read more
Find Clarity on MSP Types
Question: I'm trying to navigate situations in which a patient is a Medicare beneficiary b... Read more
Compliance:
Reach an Understanding Before Signing Agreements for Audits
Question: We are hiring an external entity to perform an audit to assess the performa... Read more
Reach an Understanding Before Signing Agreements for Audits
Question: We are hiring an external entity to perform an audit to assess the performa... Read more
Compliance:
Maintain Office Compliance With These HIPAA Tips
Staff training should be ongoing, not just once a year. As a healthcare professional freq... Read more
Maintain Office Compliance With These HIPAA Tips
Staff training should be ongoing, not just once a year. As a healthcare professional freq... Read more
Medicare Regulations:
Follow Guidelines for Beneficiary Referral Visits
Question: One of our providers saw a Medicare beneficiary who visited for a problem that o... Read more
Follow Guidelines for Beneficiary Referral Visits
Question: One of our providers saw a Medicare beneficiary who visited for a problem that o... Read more
Medicare Regulations :
Attention: Medicare Patient Appeal Changes Are Here!
Select inpatient to observation patient status changes can be scrutinized now, and even as... Read more
Attention: Medicare Patient Appeal Changes Are Here!
Select inpatient to observation patient status changes can be scrutinized now, and even as... Read more
Compliance:
Signatures Are Key to Proving Validity
Question: I was told that providers had to sign off on the encounters before creating/subm... Read more
Signatures Are Key to Proving Validity
Question: I was told that providers had to sign off on the encounters before creating/subm... Read more
Compliance:
Sharing Credentials May Mean Breaking the Law
Question: We recently signed on a new physician at our practice and they're only contracte... Read more
Sharing Credentials May Mean Breaking the Law
Question: We recently signed on a new physician at our practice and they're only contracte... Read more
Medicare Regulations:
Find Clarity on Global Surgery Inclusion
Question: A patient who's a Medicare beneficiary had surgery. They were in a lot of pain a... Read more
Find Clarity on Global Surgery Inclusion
Question: A patient who's a Medicare beneficiary had surgery. They were in a lot of pain a... Read more
Medicare Regulations:
Look for These Forms for Credentialing Adjustments
Question: I need to make an adjustment to the credentialing information for one of my prov... Read more
Look for These Forms for Credentialing Adjustments
Question: I need to make an adjustment to the credentialing information for one of my prov... Read more
Compliance:
Stay Out of Hot Water by Disposing of PHI Properly
Training seasonal and permanent staff will avoid an audit. As summer approaches, many pra... Read more
Stay Out of Hot Water by Disposing of PHI Properly
Training seasonal and permanent staff will avoid an audit. As summer approaches, many pra... Read more
Medicare Regulations:
Stay Updated on Fast-Tracked Price Transparency
Find out what the president's executive orders may mean for your organization. On Feb. 25... Read more
Stay Updated on Fast-Tracked Price Transparency
Find out what the president's executive orders may mean for your organization. On Feb. 25... Read more
Medicare Regulations:
Distinguish Redetermination From Reconsideration
Question: What's the difference between a redetermination and a reconsideration, in terms ... Read more
Distinguish Redetermination From Reconsideration
Question: What's the difference between a redetermination and a reconsideration, in terms ... Read more
Compliance:
Understand What Receiving Kickbacks From EHR Vendors Looks Like
Question: Our practice uses a vendor to provide and maintain the infrastructure of our ele... Read more
Understand What Receiving Kickbacks From EHR Vendors Looks Like
Question: Our practice uses a vendor to provide and maintain the infrastructure of our ele... Read more
Compliance:
Utilize Separate Notes
Question: We sometimes see patients who come in for services relating to incidents involvi... Read more
Utilize Separate Notes
Question: We sometimes see patients who come in for services relating to incidents involvi... Read more
Medicare Regulations:
Find Relief in G2211 Update
Question: My provider wants me to bill G2211 alongside a Medicare annual wellness visit. C... Read more
Find Relief in G2211 Update
Question: My provider wants me to bill G2211 alongside a Medicare annual wellness visit. C... Read more
Compliance:
Feel Confident When Delivering Audit Results With These Tips, Part 1
Hint: Rely on scope to determine who's going to see the results. The “A word” can mak... Read more
Feel Confident When Delivering Audit Results With These Tips, Part 1
Hint: Rely on scope to determine who's going to see the results. The “A word” can mak... Read more
Medicare Regulations:
Confidently Report Resident Care Through End of 2025
Question: Our practice relies on residents to provide some care services. Sometimes we off... Read more
Confidently Report Resident Care Through End of 2025
Question: Our practice relies on residents to provide some care services. Sometimes we off... Read more
Medicare Regulations:
Schedule ACP With QHP for Reimbursement
Question: At our practice, registered nurses (RNs) or licensed practical nurses (LPNs) esc... Read more
Schedule ACP With QHP for Reimbursement
Question: At our practice, registered nurses (RNs) or licensed practical nurses (LPNs) esc... Read more
Medicare Regulations:
Know What’s Coming, According to 2026 SNF PPS Proposed Rule
CMS will try to offset inflation — a bit — with this year's proposed rate adjustment. ... Read more
Know What’s Coming, According to 2026 SNF PPS Proposed Rule
CMS will try to offset inflation — a bit — with this year's proposed rate adjustment. ... Read more
Compliance:
State Law May Require You to Hand Over PHI
Question: If someone from law enforcement is requesting records from our office to investi... Read more
State Law May Require You to Hand Over PHI
Question: If someone from law enforcement is requesting records from our office to investi... Read more
Compliance:
Focus On These Elements to Organize Audit Findings
Make sure you're comparing apples to apples when calculating accuracy. Communicating the ... Read more
Focus On These Elements to Organize Audit Findings
Make sure you're comparing apples to apples when calculating accuracy. Communicating the ... Read more
Compliance:
Writing Off a Signature Could Cost You
Question: We recently suffered major storms and power outages in my area. All of our ... Read more
Writing Off a Signature Could Cost You
Question: We recently suffered major storms and power outages in my area. All of our ... Read more
Compliance:
Use This Website to Help Identify Fraud and Stay Compliant
Protect yourself by staying current on government-impersonating scammers. The Office of t... Read more
Use This Website to Help Identify Fraud and Stay Compliant
Protect yourself by staying current on government-impersonating scammers. The Office of t... Read more
Medicare Regulations:
Know the Ins and Outs of Medicare Rules Regarding Disasters
Keep an eye out for blanket waivers, which can make associated paperwork less burdensome. ... Read more
Know the Ins and Outs of Medicare Rules Regarding Disasters
Keep an eye out for blanket waivers, which can make associated paperwork less burdensome. ... Read more
Medicare Regulations:
Find These Coding Options for Skin Substitutes
Question: My provider does wound care for patients, including Medicare beneficiaries, with... Read more
Find These Coding Options for Skin Substitutes
Question: My provider does wound care for patients, including Medicare beneficiaries, with... Read more
Compliance:
Be Wary of Varying Billing Practices Between Payers
Question: Our orthopedic practice sometimes has situations where patients come in with the... Read more
Be Wary of Varying Billing Practices Between Payers
Question: Our orthopedic practice sometimes has situations where patients come in with the... Read more
Medicare Regulations Understand Regulations for Hospice Attestation
Question: Does a provider need a particular credential to be able to perform an attestatio... Read more
Question: Does a provider need a particular credential to be able to perform an attestatio... Read more
Compliance:
Using AI? Prioritize These Regulations and Rules
Question: Our practice leadership wants to incorporate more artificial intelligence (AI) i... Read more
Using AI? Prioritize These Regulations and Rules
Question: Our practice leadership wants to incorporate more artificial intelligence (AI) i... Read more
Medicare Regulations:
Beware Phishing Attempts Regarding CMS
Question: I am hearing from other providers and even some suppliers that they are receivin... Read more
Beware Phishing Attempts Regarding CMS
Question: I am hearing from other providers and even some suppliers that they are receivin... Read more
Medicare Regulations:
Find Clarity on Hospice Payment Responsibilities for Medicare Beneficiaries
Question: A beneficiary's family has agreed that their family member is ready to be put in... Read more
Find Clarity on Hospice Payment Responsibilities for Medicare Beneficiaries
Question: A beneficiary's family has agreed that their family member is ready to be put in... Read more
Compliance:
OIG Finds Most Medicare Outpatient Hospital Payments for Hospice Enrollees Improper
See which issues they discovered and the key element you need to help reduce exposure. In... Read more
OIG Finds Most Medicare Outpatient Hospital Payments for Hospice Enrollees Improper
See which issues they discovered and the key element you need to help reduce exposure. In... Read more
Medicare Regulations:
Experiencing Behavioral Health Denials? Here’s What To Do
Find out how to stay compliant and keep the payments coming. More Medicare beneficiaries ... Read more
Experiencing Behavioral Health Denials? Here’s What To Do
Find out how to stay compliant and keep the payments coming. More Medicare beneficiaries ... Read more
Compliance:
Know Who Can Record Diagnosis Information
Question: I'm new to coding and am looking over an internal audit at a skilled nursing fac... Read more
Know Who Can Record Diagnosis Information
Question: I'm new to coding and am looking over an internal audit at a skilled nursing fac... Read more
Compliance:
Look to These Resources for Compliant Overpayment Recoupment
Question: Is there a specific window in which payers are entitled to recoup any overpaymen... Read more
Look to These Resources for Compliant Overpayment Recoupment
Question: Is there a specific window in which payers are entitled to recoup any overpaymen... Read more
Medicare Regulations:
Attack Financial and Operational Impact of Denials
Question: I've read that the Centers for Medicare & Medicaid Services (CMS) is increas... Read more
Attack Financial and Operational Impact of Denials
Question: I've read that the Centers for Medicare & Medicaid Services (CMS) is increas... Read more
Compliance:
Decide on This Date of Service Confusion
Question: We have a provider who saw a patient and recommended surgical intervention. The ... Read more
Decide on This Date of Service Confusion
Question: We have a provider who saw a patient and recommended surgical intervention. The ... Read more
Compliance:
Protect Your Practice by Considering These Compliance Tips
Adding helpful websites to your favorites may save you later. Colleen Gianatasio, MHS, CP... Read more
Protect Your Practice by Considering These Compliance Tips
Adding helpful websites to your favorites may save you later. Colleen Gianatasio, MHS, CP... Read more
Compliance:
File Paper Records Safely Away Permanently
Question: Because our clinic is relocating in a few months, we are working on digital... Read more
File Paper Records Safely Away Permanently
Question: Because our clinic is relocating in a few months, we are working on digital... Read more
Medicare Regulations:
SBIRT Services Expanded for Medicare
Take a quick look at what's new. In a July 2025 MLN Connects newsletter, the Centers for ... Read more
SBIRT Services Expanded for Medicare
Take a quick look at what's new. In a July 2025 MLN Connects newsletter, the Centers for ... Read more
Medicare Regulations:
Incorporate These Revised Medicare Signature Requirements
Question: We are reviewing policies and procedures to ensure we are compliant with Centers... Read more
Incorporate These Revised Medicare Signature Requirements
Question: We are reviewing policies and procedures to ensure we are compliant with Centers... Read more
Compliance:
Use These Tips for DME Compliance
Question: I'm a newbie to durable medical equipment (DME) and not exactly sure what we nee... Read more
Use These Tips for DME Compliance
Question: I'm a newbie to durable medical equipment (DME) and not exactly sure what we nee... Read more
Medicare Regulations:
Prepare Now for OPPS and ASC Payment System Changes Coming in CY 2026
The policy's fine print holds some surprises. The Centers for Medicare & Medicaid Ser... Read more
Prepare Now for OPPS and ASC Payment System Changes Coming in CY 2026
The policy's fine print holds some surprises. The Centers for Medicare & Medicaid Ser... Read more
Compliance:
Protect Role Integrity With Policies and Adequate Staffing
Question: I am a certified professional coder (CPC®) and certified professional medical a... Read more
Protect Role Integrity With Policies and Adequate Staffing
Question: I am a certified professional coder (CPC®) and certified professional medical a... Read more
Medicare Regulations:
Inquire With Patient Regarding Part B Status Post-Incarceration
Question: A patient who comes to our practice was a Medicare beneficiary but was convicted... Read more
Inquire With Patient Regarding Part B Status Post-Incarceration
Question: A patient who comes to our practice was a Medicare beneficiary but was convicted... Read more
Medicare Regulations:
Prepare Adequately for Medicare Claim Submission for Polysomnography
Question: A provider sees a Medicare beneficiary and has them evaluated via a sleep study.... Read more
Prepare Adequately for Medicare Claim Submission for Polysomnography
Question: A provider sees a Medicare beneficiary and has them evaluated via a sleep study.... Read more
Compliance Coding:
Don’t Let Vendors Become a Compliance Weak Spot
Do your due diligence on vendor trustworthiness before signing any contracts. Many practi... Read more
Don’t Let Vendors Become a Compliance Weak Spot
Do your due diligence on vendor trustworthiness before signing any contracts. Many practi... Read more
Compliance:
Remain HIPAA Compliant While Transitioning to Digital
Question: I'm a manager at an office that still uses a lot of paper. We are looking to fin... Read more
Remain HIPAA Compliant While Transitioning to Digital
Question: I'm a manager at an office that still uses a lot of paper. We are looking to fin... Read more
Medicare Regulations:
Find Out Which Proposals Made the MPFS Final Rule
The final conversion factors are lower than what CMS initially proposed. The Centers for ... Read more
Find Out Which Proposals Made the MPFS Final Rule
The final conversion factors are lower than what CMS initially proposed. The Centers for ... Read more
Compliance:
Leverage the Payers’ Resources to Keep More of Your Claim Payment
Learn how to use each payers tools to your practice's advantage. Although every practice ... Read more
Leverage the Payers’ Resources to Keep More of Your Claim Payment
Learn how to use each payers tools to your practice's advantage. Although every practice ... Read more
Compliance:
Tighten Up Your E-Signature Security
Question: During a recent risk assessment audit, it was found that our e-signatures, ... Read more
Tighten Up Your E-Signature Security
Question: During a recent risk assessment audit, it was found that our e-signatures, ... Read more
Medicare Regulations:
Consider Dx Complexity When Billing G2211
Question: I think the code descriptor for G2211 makes it seem like a coder can't bill G221... Read more
Consider Dx Complexity When Billing G2211
Question: I think the code descriptor for G2211 makes it seem like a coder can't bill G221... Read more
Medicare Regulations:
Use These Tools to Check Eligibility
Question: We regularly see new patients, many of whom are Medicare beneficiaries. I know b... Read more
Use These Tools to Check Eligibility
Question: We regularly see new patients, many of whom are Medicare beneficiaries. I know b... Read more